Prevalence and Determinants of Vaccine Hesitancy Among Caregivers of Children Aged 0-59 Months in Urban Settings of Buea, Cameroon

Background: Vaccine hesitancy, defined as reluctance or refusal to vaccinate despite vaccine availability, represents one of the ten leading threats to global public health. In Cameroon, vaccine hesitancy has reached concerning levels, with previous studies documenting an 84.6% vaccine hesitancy rate for COVID-19 vaccines among adults and only 31.21% expressing willingness to accept vaccination. Understanding the determinants of vaccine hesitancy among caregivers of young children is crucial for developing targeted interventions.
Methodology: This community-based cross-sectional analytical study was conducted in urban settings of Buea, Cameroon. A multistage sampling technique was employed to recruit 438 caregivers of children aged 0–59 months. Data were collected using a structured, interviewer-administered questionnaire incorporating a modified version of the WHO SAGE Vaccine Hesitancy Scale. Bivariate and multivariate logistic regression analyses were performed to identify significant determinants of vaccine hesitancy.
Results: The prevalence of vaccine hesitancy was 11.0% among caregivers. Significant determinants included gender (females less likely to exhibit hesitancy: AOR = 0.245, 95% CI: 0.075–0.805), income (higher income associated with lower hesitancy: AOR = 0.211, 95% CI: 0.056–0.799), caregiver status (shared caregiving associated with higher hesitancy: AOR = 4.931, 95% CI: 1.596–15.230), family influence (no family influence increased hesitancy: AOR = 2.801, 95% CI: 1.120–7.006), and cultural beliefs (AOR = 5.748, 95% CI: 2.446–13.508). Behavioral factors strongly associated with hesitancy included missed health appointments (AOR = 33.519, 95% CI: 9.053–124.103), delayed vaccination schedules (AOR = 17.431, 95% CI: 4.171–72.845), and cultural practices (AOR = 21.971, 95% CI: 7.305–66.077).
Conclusion: The study identified multiple determinants of vaccine hesitancy operating at individual, social, and cultural levels. The findings underscore the need for culturally appropriate interventions that address deeply rooted factors influencing vaccination decisions among caregivers in Cameroon.

Vaccine hesitancy; caregivers; children; immunization; determinants; cultural factors; Cameroon; Buea

1. Acharya, S., Aechtner, T., Venaik, S., & Dhir, S. (2024). Bibliometric analysis of vaccine hesitancy research from behavioural perspectives (2015–2022). Journal of Risk Research, 27(2), 238–253. [Google Scholar] [Crossref]

2. Ames, H., Njang, D. M., Glenton, C., et al. (2015). Mapping how information about childhood vaccination is communicated in two regions of Cameroon: What is done and where are the gaps? BMC Public Health, 15, 1264. [Google Scholar] [Crossref]

3. Aminde, L. N., Atem, J. A., Kengne, A. P., Dzudie, A., & Veerman, J. L. (2017). Body mass index measured adiposity and population attributability of associated factors: a population-based study from Buea, Cameroon. BMC Obesity, 4(1), 1. [Google Scholar] [Crossref]

4. Ashiru-Oredope, D., Nabiryo, M., Zengeni, L., et al. (2023). Tackling antimicrobial resistance: developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model. Journal of Public Health in Africa, 14(6), 7. [Google Scholar] [Crossref]

5. Aseneh, J. B., Agbor, V. N., Kadia, B. M., Okolie, E. A., Ofomata, C. J., Ekaney, D. S. M., Etombi, C. L., & Joko Fru, Y. W. (2023). Factors associated with COVID-19 vaccine hesitancy among healthcare workers in Cameroon and Nigeria: A web-based cross-sectional study. International Health, 15(6), 702–714. [Google Scholar] [Crossref]

6. Abongwa, L. E., Sumo, L., Ngum, N. H., Muhammed, N. N., Synthia Njiwale, M., Miriam Nakuh, N., & Nayah, M. N. (2022). A survey on factors influencing COVID-19 vaccine hesitancy in Bamenda-Cameroon. Journal of Advances in Microbiology, 1–14.Buea. (2024). In Wikipedia. [Google Scholar] [Crossref]

7. Challenges of Language Barrier on the Health Services in Multilingual Cameroon: The Case of the North West Region. (2024). [Google Scholar] [Crossref]

8. Cheuyem, F. Z. L., Amani, A., Nkodo, I. C. A., Boukeng, L. B. K., Edzamba, M. F., Nouko, A., Guissana, E. O., Ngos, C. S., Achangwa, C., & Mouangue, C. (2024). COVID-19 vaccine acceptance and hesitancy in Cameroon: A systematic review and meta-analysis. [Google Scholar] [Crossref]

9. Cho, F. N., Ngah, Y. E., Tassang, A. N., Fru, C. N., Kuku Elad, P. C., Jokwi, P. K., Folefac, V. N., Esa, I., & Fru, P. N. (2023). Face mask ownership/utilisation and COVID-19 vaccine hesitancy amongst patients recovering from COVID-19 in Cameroon: A cross-sectional study. PLoS ONE, 18(1), e0280269. [Google Scholar] [Crossref]

10. Dinga, J. N., Sinda, L. K., & Titanji, V. P. K. (2021). Assessment of vaccine hesitancy to a COVID-19 vaccine in Cameroonian adults and its global implication. Vaccines, 9(2), 175. [Google Scholar] [Crossref]

11. Dinga, J. N., Njoh, A. A., Gamua, S. D., Muki, S. E., & Titanji, V. P. K. (2022). Factors driving COVID-19 vaccine hesitancy in Cameroon and their implications for Africa: A comparison of two cross-sectional studies conducted 19 months apart in 2020 and 2022. Vaccines, 10(9), 1401. [Google Scholar] [Crossref]

12. Evans, W. D., Bingenheimer, J. B., Long, M., et al. (2023). Outcomes of a social media campaign to promote COVID-19 vaccination in Nigeria. PloS One, 18(9), e0290757. [Google Scholar] [Crossref]

13. Kamtchueng, L. M. M. (2024). Healthcare providers' experience of non-linguistic barriers to healthcare provision for official language illiterate patients in Far-North Cameroon healthcare centers: A contribution to intercultural communication. Journal of Language and Health, 5(1), 167–180. [Google Scholar] [Crossref]

14. Lazarus, J. V., Ratzan, S. C., Palayew, A., Gostin, L. O., Larson, H. J., Rabin, K., Kimball, S., & El-Mohandes, A. (2021). A global survey of potential acceptance of a COVID-19 vaccine. Nature Medicine, 27(2), 225–228. [Google Scholar] [Crossref]

15. Madzorera, I., Abokyi, L. N., Apraku, E., et al. (2025). Perceptions and predictors of COVID-19 vaccine hesitancy among healthcare providers across five countries in sub-Saharan Africa. PLoS Global Public Health, 5(2), e0003956. [Google Scholar] [Crossref]

16. Maamor, N. H., Muhamad, N. A., Mohd Dali, N. S., et al. (2024). Prevalence of caregiver hesitancy for vaccinations in children and its associated factors: A systematic review and meta-analysis. PLOS ONE, 19(10), e0302379. [Google Scholar] [Crossref]

17. Mandaah, F. V., Nicholas, T., Esemu, S. N., Vanessa, A. B. T., Destin, K. T. G., Atiepoh, N. C., & Vanessa, L. F. (2020). Trends in the population knowledge, attitudes and practices toward COVID-19 in the Buea municipality two months after the onset of the pandemic in Cameroon. The Pan African Medical Journal, 37, 134. [Google Scholar] [Crossref]

18. Nah, S., Williamson, L. D., Kahlor, L. A., Atkinson, L., Ntang-Beb, J.-L., & Upshaw, S. J. (2023). COVID-19 vaccine hesitancy in Cameroon: The role of medical mistrust and social media use. Journal of Health Communication, 28(9), 619–632. [Google Scholar] [Crossref]

19. Nicholas, T., Mandaah, F. V., Esemu, S. N., Vanessa, A. B. T., Gilchrist, K. T. D., Vanessa, L. F., & Shey, N. D. (2020). COVID-19 knowledge, attitudes and practices in a conflict affected area of the South West Region of Cameroon. The Pan African Medical Journal, 35(Suppl 2), 34. [Google Scholar] [Crossref]

20. Ngalle, E. E. (2021). The spatial distribution of road network and its impact on commercial activities in Buea municipality. Transportation Geography. [Google Scholar] [Crossref]

21. Ngwa, C. H., Doungtsop, B. C. K., Bihnwi, R., Ngo, N. V., & Yang, N. M. (2018). Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon. Human Vaccines & Immunotherapeutics, 18(1), 1939620. [Google Scholar] [Crossref]

22. Nkemngong, D. E. M., Tita, J. C., Nengieh, W. L., & Mesumbe, N. N. (2024). Social media's influence on vaccine hesitancy among students of higher education institutions in Cameroon: The case of COVID-19 vaccines. Advances in Journalism and Communication, 12(03), 451–473. [Google Scholar] [Crossref]

23. Njoga, E. O., Awoyomi, O. J., Onwumere-Idolor, O. S., Awoyomi, P. O., Ugochukwu, I. C. I., & Ozioko, S. N. (2022). Persisting vaccine hesitancy in Africa: The whys, global public health consequences and ways-out – COVID-19 vaccination acceptance rates as case-in-point. Vaccines, 10(11), 1934. [Google Scholar] [Crossref]

24. Saidu, Y., Gu, J., Michael Ngenge, B., et al. (2024). Improving childhood immunization service delivery in Cameroon: A synthesis of caregiver experiences and recommendations. Vaccines, 12(12), 1430. [Google Scholar] [Crossref]

25. Wang, D., Chukwu, A., Mwanyika-Sando, M., et al. (2022). COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents. PLoS Global Public Health, 2(10), e0000611. [Google Scholar] [Crossref]

26. Wormald, B. (2015). The future of world religions: Population growth projections, 2010–2050. Pew Research Center. [Google Scholar] [Crossref]

27. Yakum, M. N., Funwie, A. D., Ajong, A. B., Tsafack, M., Ze, L. E., Shah, Z. (2022). The burden of vaccine hesitancy for routine immunization in Yaounde-Cameroon: A cross-sectional study. PLoS Global Public Health, 2(9), e0001012. [Google Scholar] [Crossref]